노인 요양시설 간호사의 간호행위 분류 The classification of Nurse's Nursing Activities in Nursing Home for Elderly

Abstract

The number of nurses working at the institution for the elderly accounted for 281 as of 1998(the Ministry of Health and Wellbeing), which amounted to 10.4% of the number of the employees at all the institutions for the elderly. Nevertheless, there do not exist any specialized in-service education, organization and meeting for nurses working in the nursing home, and their activity is not known at all. Few studies on the nursing field of the nursing home is almost absent, and studies on the intention to use the nursing home, the determinants to use it, the development of the nursing home model and the like have been conducted for the recent 2 to 3 years. And some studies have been conducted on the health characteristics of the elderly resident at the nursing home, comparison of the function of daily life and the like. Studies on the nurse's job have never been conducted. In particular, the guidebook for the job of nurses is not only provided but even the level of job and role is not known. That is, the overall fact is not known as to what role the nurse perform at the nursing home and whether the nurse is needed at all at the nursing home. It is thought that this study will help to provide the quality nursing home for the comfort of the increasing old population For this purpose, it is necessary to investigate what the job of the nurse working in the nursing home is, identify the job of the nurse in the nursing home, establish the status of the nurse in the nursing home, assist in secure the nursing manpower to the optimal level and raise the quality of the nurse's service quality. This study was intended to identify and classify the nursing activities of nurses working in the nursing home. It was the basic research to establish the identity of nurses in the nursing home working in the nursing home for the elderly in Korea by identifying the nursing activities relating to the role and function of nurses providing nursing services in the nursing home for the elderly. It was the one to provide the elderly with quality nursing services and further strengthen the role and function of nurses as the subject of the nursing home, the expanded nursing role of nurses in the nursing home for the elderly. The specific purpose of study was to investigate the nursing activities of nurses in the nursing home for the elderly, test the validity of their nursing activities and classify their nursing activities. The research method included the literature review, the field survey, the interview, the business log analysis. This study investigated the nursing activities of nurses working in the nursing home, investigated its validity through the focus group and drew 116 items concerning the nursing activities. And to confirm the validity of this nursing activities through practicing nursing, this study conducted the questionnaire research on 92 practicing nurses working in the paid, "cost" and free-charging nursing home. Of them, 38 items were excluded and finally 78 items on the nursing activities of nurses working in the nursing home were accepted. Data analysis was conducted using the SAS statistical program. Data were analyzed on the general characteristics, nursing activities and frequency of nurses working in the nursing home using frequency and percentage. Mean and standard deviation were calculated on the frequency and content of nursing activities. Analysis was conducted on the difference in nursing activities according to types of nursing homes. As a result, the nursing activities of nurses working in the nursing home was divided into 78 nursing activities pertaining to 13 domains. The first domain was the nursing domain of respiration which included the followings: all kinds of basic check up; T.P.R; aspiration; oxygen therapy; use of the humidifier; cardiopulmonary resuscitation(artificial respiration); evaluation of the level of satisfaction; the evaluation of nursing quality; and the like. The second nutrition domain was the nursing one which included the followings: all kinds of basic checkup; confirmation of the problem; confirmation of the checkup results; diagnosis of the problem; treatment and management plan; weight measurement; measurement of blood sugar; measurement of intake and output; supply of oral nutrition; supply of nutrition through the intestinal tract; intubation and its management; nutritional improvement; evaluation of the satisfaction level; evaluation of nursing quality and the like. The third domain was the nursing one of elemination which included the followings: all kinds of checkup; confirmation of the problem; confirmation of the checkup results; enema; catheterization; catheter management; insertion of tubes of all kinds and management; evaluation of the satisfaction level; evaluation of nursing quality; and the like. The fourth domain was the excercise/ posture maintenance one which included the followings: change of position; application of elastic bandage; exercise; physical therapy; and the like. The fifth domain was the nursing one of security which included the followings: coldness and warmth therapy; measurement of body temperature; application of sandbag; assistance in going to hospital or shopping; recreation; companion with whom they can chat; emotional support; money management; and the like. The sixth domain was the sanitary nursing one which included the followings: tooth brushing; shampooing; bathing; sitz bath; shaving and cleaning; hot sitz bath; and the like. The seventh domain was the nursing one of safety which included the followings: aseptic technique; infection management; management of wound from the surgical operation; bedsore treatment; wound dressing; prevention from falling; blood pressure measurement; pulse measurement; and the like. The eight domain was the communication one which included the followings: judgement of the patient's condition; multidisciplinary approach; solicitation for different jobs; commission to and counselling with doctors; invitation for hospitalization; referral to other medical institutions; communication for safety management; supervision and education of life supporters; and the like. The ninth domain was the spiritual nursing one which included nursing for death. The tenth domain was the counseling and educational one which included the followings: health promotion education; nutritional education; abstinence education; drug disabuse and abuse education; diseases and their treatment; education on side effects; information on how to use all kinds of equipment and drug; counseling with the guardian of the elderly; and the like. The eleventh domain was the dosage one which included the followings: oral dosage; IV; IM; SQ injection(hypodermic injection); transfusion; and the like. The twelfth domain was the patient nursing management/information management domain which included the followings: the rounding of the nursing home; drawing up the nursing log; article management; safety and environmental management; the plan to discharge from a hospital; and the like. The thirteenth domain was the program development one, as the one added to this study, which included the followings: on-the-job training on nurses; other technical education; community resident health promotion job; and the like. Nursing activities related to the role of nurses not included in 12 existing domains such as specialized on-the-job training and other special education for nurses and nursing activities such as promotion of local community residents are the field that can place emphasis on speciality as the nurse of the nursing home for the elderly. Thus this was added to the program development domain as it was thought that it was necessary to classify it as another domain. An attempt was made to make a comparison between clinical nursing activities and nursing activities in the nursing home for the elderly. As a result, it could be found that greater emphasis was placed on nursing activities in the communication, counseling and education and security nursing domains in the nursing home than on clinical nursing activities, which indicates that nursing activities was mentioned in concrete and diverse ways. This study has its significance of nursing studies in that it systematically sought to draw and classify nursing activities of the nurses working in the nursing home for the elderly in terms of nursing theories. In terms of nursing practice, this study had its significant meaning in that it set the criterion for unclear jobs of nursers in the community setting by using the classification of nursing activities of nurses working in the nursing home for the elderly, established technical differentiation from other categories of occupation and provided for job guidelines of nurses working in the nursing home as basic material. And it provided basic material for calculating the price for nursing services and the proper number of nursing manpower within the nursing home for the elderly. In terms of nursing education, this study ascertained what was the nursing activities to strengthen for nurses within the nursing home for the elderly so that it might apply to the nursing curriculum. This study had some limitation in drawing the nursing activities proper to the nursing home for the elderly in greater depth because the model of classification framework used in this study was related to the clinical nursing activities studied for general hospital. Accordingly, it is thought that it is more necessary to make the future study of its refinement. Moreover, it is necessary to set the job standard of each nursing activities. Based on the results, the following suggestion was presented: 1) Educational Aspect - It is necessary to develop and apply the curriculum to produce nurses armed with the proper level of quality and ability as nursing manpower for the elderly. - It is necessary to develop the educational program related to specialized nurses for the elderly. 2) Research Aspect - It is necessary to identify the job overlapping with other job series, especially the job of social worker in the nursing home for the elderly and attempt to make a job analysis to probe cooperation with other job series. - It is necessary to attempt to develop the job curriculum for nurses in the nursing home through the developed job. 3) Practical Aspect - It is necessary to develop the job guidebook by embodying the list of jobs developed through expanded research. - It is necessary to reinforce the mediating role in enhancing the qualitative level of direct nursing. - It is necessary to reinforce the role as the developer of the program for the nursing home. - It is necessary to intensify the mediating role of the nurse in balancing the power relationship between employees in the nursing home. 4) Policy Aspect - It is necessary to measure manpower demand according to the type of nursing homes and to the quality of nurses' job. - The national classification system is needed that is enforced in compliance with the national, uniform and objective standard in order to provide efficient medical services. And it is necessary to build the nursing home specialized according to the disease condition of old people. - It is necessary to introduce the system of nursing specializing in the elderly.;노인인구의 증가, 핵가족화와 여성의 사회참여 증가, 개인주의 확산에 따른 노인의 독립생활의 촉진, 사회보장제도의 발달로 인한 노인부양이 가정에서 노인요양시설로 이행되는 추세로 앞으로 시설거주 노인이 늘어날 것이며 간호인력들이 시설에 거주하는 노인들을 돌볼 기회 또한 증가될 것이다. 이에 따라 본 연구는 우리나라의 노인요양시설에서 간호를 제공하는 간호사의 역할과 기능에 대한 간호행위를 규명하고 분류하므로 한국의 노인 요양시설 간호사의 정체성을 확립하고, 노인 대상자들에게 양질의 간호를 제공하고 더 나아가서는 간호의 확대된 역할인 요양시설의 주체로서 간호사의 역할과 기능을 강화시키기 위해 시도되었다. 본 연구의 구체적인 연구목적은 노인요양시설 간호사의 간호행위를 조사하고, 간호행위의 타당도를 검증하고, 간호행위를 분류하는 것이다. 자료수집 기간은 2002년 8월 23일부터 10월 13일까지 약 2개월 간이었다. 연구의 대상은 보건복지부에 등록되어 있고, 전국에 분포하고 있는 288개의 노인복지시설 중 162개의 무료, 실비, 유료노인요양시설에서 근무하는 간호사 중 연구의 목적에 동의하여 우편으로 설문조사에 응한 92명을 연구 대상으로 하였다. 연구도구는 문헌고찰, 현장조사, 인터뷰, 업무일지 분석을 통해 간호행위를 조사하여 초점집단에 타당도를 검증한 후, 연구자가 작성한 설문지로 일반적 특성 17문항, 간호행위 116문항으로 구성하였다. 본 연구에서의 Cronbach's α=.72로 나타났다. 자료분석은 SAS 통계 프로그램을 이용하여 분석하였다. 노인요양시설 간호사의 일반적 특성, 간호행위, 빈도 등은 빈도, 백분율로, 간호행위빈도, 내용은 평균과 표준편차, 요양시설 유형에 따른 간호행위는 ANOVA분석을 하였다. 연구결과 노인요양시설 간호사의 간호행위는 대분류 6개 영역, 중분류 13개 영역, 소분류 78개 간호행위로 분류되었다. 대분류는 건강관리, 일상생활보조, 투약, 협조/관리/조정, 교육/상담, 프로그램 개발 등 6개로 분류하였고, 중분류는 호흡간호, 영양간호, 배설간호, 운동 및 자세유지, 안위간호, 위생, 안전간호, 투약, 의사소통, 환자간호관리 및 정보관리, 영적지지, 상담 및 교육, 프로그램 개발 등의 13개 영역으로 분류하였다. 소분류는 각종기초검사, 문제점 확인, 검사결과확인, 활력증후측정, 흡인, 산소요법, 가습기 사용, 심폐소생술(인공호흡), 대상자 만족도 평가, 간호의 질평가, 체중측정, 혈당측정, 섭취량 배설량 측정, 구강영양공급, 장관영양공급, 튜브삽입 및 관리, 영양개선, 관장, 인공도뇨, 카테터관리, 각종 튜브 삽입 및 관리, 체위변경, 탄력붕대적용, 운동, 물리치료, 냉온요법, 체온측정, 모래주머니 적용, 병원갈 때 돕기, 쇼핑돕기, 레크리에이션, 말동무, 정서적지지, 금전관리, 이닦기, 머리감기, 목욕, 뒷물, 면도 및 세척, 좌욕, 무균술, 감염관리, 수술상처관리, 욕창치료, 상처드레싱, 낙상방지, 혈압측정, 맥박측정, 대상자 상태 판단, 치료 및 관리계획, 타직종간 의뢰, 의사에게 의뢰 및 상담, 입원권유, 타의료기관소개, 안전관리를 위한 의사소통, 생활보조원 감독 및 교육, 임종간호, 건강증진교육, 영양교육, 금연교육, 절주교육, 약물 오,남용 교육, 질병이나 치료법, 부작용에 대한 교육, 각종 기구나 약물사용법 알려주기, 대상자, 보호자 상담, 경구투약, 정맥주사, 근육주사, 피하주사, 수혈, 노인요양시설순회, 간호기록지작성, 물품관리, 안전 및 환경관리, 퇴원계획, 간호사 보수 교육, 기타전문교육, 지역사회연계 및 자원활용 등의 78개 간호행위로 분류되었다.